Acta otorrinolaringologica espanola最新文献

{"title":"Mepolizumab in chronic rhinosinusitis with severe nasal polyposis: Real-life Spanish cohort study","authors":"Paula Cruz-Toro,&nbsp;Mireia Golet,&nbsp;Albert Llansana-Rios,&nbsp;Ignacio Clemente-Agodino,&nbsp;Laura Pardo-Muñoz,&nbsp;Carlota Gonzalez-Lluch,&nbsp;Xavier Gonzalez-Compta","doi":"10.1016/j.otorri.2026.512335","DOIUrl":"10.1016/j.otorri.2026.512335","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammation-driven condition that causes nasal blockage, olfactory loss, and diminished quality of life. Standard therapies often result in recurrence in severe cases. Mepolizumab, a monoclonal antibody targeting interleukin-5 (IL-5), has demonstrated efficacy in improving clinical symptoms and patient-reported outcomes in phase 3 trials and real-world studies.</div></div><div><h3>Aims</h3><div>To assess the real-life efficacy and safety of mepolizumab in patients with CRSwNP, both with and without comorbid asthma, over a 12-month period, focusing on nasal symptoms, polyp size, and olfactory function.</div></div><div><h3>Methods</h3><div>A multicentric, prospective observational study was conducted in three hospitals in Catalonia, Spain, involving 28 adult patients with severe CRSwNP treated with mepolizumab (100 mg subcutaneously every 4 weeks). Assessments were performed at baseline, 6, and 12 months. Outcomes included Nasal Polyp Score (NPS), Sinonasal Outcome Test-22 (SNOT-22), visual analogue scales (VAS) for symptoms and smell, and the 48- complete version of the Sniffin’ Sticks Smell Test.</div><div>Blood eosinophil count and adverse events were also recorded.</div></div><div><h3>Results</h3><div>Significant improvements were observed in NPS, SNOT-22, and symptom VAS at both 6 and 12 months (<em>P</em> &lt; .05). Olfactory function improved significantly at 12 months, while subjective olfactory VAS did not. Blood eosinophils decreased sharply. Patients with asthma and Aspirin-Exacerbated Respiratory Disease (AERD) showed greater clinical benefit. No serious adverse events occurred.</div></div><div><h3>Conclusions</h3><div>Mepolizumab appears safe and effective for severe CRSwNP, offering substantial clinical and endoscopic improvement. Olfactory gains at one year suggest prolonged treatment may be necessary for sensory recovery.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512335"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotidartery stenosis and auditory dysfunction: A systematic review of mechanisms and interventions","authors":"Gulruh Shodmonkulova,&nbsp;Gavkhar Khaydarova,&nbsp;Abdurasul Yulbarisov,&nbsp;Nasiba Rasulova,&nbsp;Dilorom Shodmonkulova","doi":"10.1016/j.otorri.2026.512331","DOIUrl":"10.1016/j.otorri.2026.512331","url":null,"abstract":"<div><div>Carotid artery stenosis (CAS), caused by atherosclerotic narrowing of the carotid arteries, has been increasingly recognized as a possible contributor to auditory dysfunction, particularly hearing loss. Several studies have demonstrated an association between CAS and hearing impairment, suggesting that the link is multifactorial and may involve reduced cochlear perfusion, oxidative stress, and vascular–anatomical interactions within the auditory system.</div></div><div><h3>Methods</h3><div>This systematic review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251130269). A comprehensive search was performed in PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed clinical studies, systematic reviews, and experimental research investigating the association between CAS and hearing impairment using audiometry, Doppler ultrasound, angiography, or MRI. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool.</div></div><div><h3>Results</h3><div>Twenty-six eligible studies met the inclusion criteria. The selected literature comprised clinical and experimental studies evaluating the relationship between CAS and auditory dysfunction. High-frequency sensorineural hearing loss and persistent tinnitus were frequently observed before neurological or cerebrovascular symptoms. Doppler ultrasonography and MRI were consistently used to assess vascular and auditory parameters, improving diagnostic accuracy.</div></div><div><h3>Conclusion</h3><div>This review supports growing evidence that carotid artery stenosis may represent a potential risk factor for hearing impairment. Audiological symptoms such as hearing loss and tinnitus could serve as early indicators of cerebral ischemia. Routine carotid artery screening is recommended for patients with unexplained auditory complaints. In severe cases, surgical or endovascular revascularization (endarterectomy or stenting) may improve both cerebrovascular outcomes and auditory function.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512331"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress and challenges in laryngeal cancer mortality in Spain, 1999–2023","authors":"Lucia Cayuela,&nbsp;Gema Flox-Benítez,&nbsp;Victoria Achaval Rodríguez,&nbsp;Julián Librero,&nbsp;Aurelio Cayuela","doi":"10.1016/j.otorri.2026.512327","DOIUrl":"10.1016/j.otorri.2026.512327","url":null,"abstract":"<div><h3>Background and objective</h3><div>Laryngeal cancer remains a significant public health concern, with pronounced sex- and age-related disparities in mortality. In Spain, recent national analyses are scarce. This study provides a comprehensive assessment of laryngeal cancer mortality trends from 1999 to 2023 and disentangles the contributions of age, period, and cohort effects.</div></div><div><h3>Methods</h3><div>We conducted a population-based time-series analysis of laryngeal cancer mortality in Spain over a 25-year period (1999–2023). Age-standardised mortality rates (ASMRs) were calculated, and Joinpoint Regression identified temporal trends. Age-Period-Cohort (A-P-C) modelling (for ages 35–84) decomposes changes into effects attributable to age, period (reflecting clinical management), and birth cohort (reflecting generational risk factor exposure).</div></div><div><h3>Results</h3><div>A total of 36,598 deaths were recorded, 94% among men. Male ASMRs fell sharply from 12.10 to 4.76 per 100,000, with an annual percentage change (APC) of <strong>−</strong>4.0%. Female ASMRs remained largely stable. APC modelling for men showed a strong negative net drift (−6.27%), driven by a pronounced negative cohort effect, with rate ratios declining from the 1919–1984 birth cohort. In women, APC analysis revealed an age-dependent reversal: mortality declined in younger women but increased significantly in those aged 55 and over (e.g., APC <strong>+</strong>4.13% at ages 60–64).</div></div><div><h3>Conclusion</h3><div>Male laryngeal cancer mortality in Spain has declined markedly, primarily due to decreasing smoking-related cohort risks. The rising mortality in older women reflects the delayed impact of past smoking uptake. Continued, gender-sensitive tobacco control strategies are essential.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512327"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of hyaluronic acid gel as an adjunct to temporalis fascia graft tympanoplasty in total tympanic membrane perforation: A randomized controlled trial","authors":"Ahmed Hemdan,&nbsp;Nourhan Moustafa Abd Elkhalek,&nbsp;Waleed Moneir,&nbsp;Ahmed Musaad Abd El-Fattah","doi":"10.1016/j.otorri.2026.512334","DOIUrl":"10.1016/j.otorri.2026.512334","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to evaluate the efficacy of hyaluronic acid gel as an adjunct to temporalis fascia graft tympanoplasty in total tympanic membrane perforation.</div></div><div><h3>Methods</h3><div>A prospective single blinded randomized controlled trial carried out among 60 patients with total tympanic membrane perforation randomized into 2 groups A&amp;B each comprised of 30 patients. Patients in group A underwent underlay tympanoplasty using temporalis fascia graft through postauricular approach with the utilization of hyaluronic acid gel as an adjunct to temporalis fascia graft. Patients in group B underwent classic underlay tympanoplasty using temporalis fascia graft through postauricular approach. Both groups were compared as regards graft success rate as well as hearing outcome.</div></div><div><h3>Results</h3><div>The difference in the graft success rate between group A (93.33%) and group B (80%) was statistically significant (<em>P</em> value = .04). Preoperative air conduction (AC) threshold and air bong gap (ABG) showed no statistically significant differences between both groups. Postoperative AC thresholds for groups A and B were 23.55 ± 3.69 dB and 26.40 ± 5.26 dB respectively with statistically significant difference (<em>P</em> value = .04). Postoperative ABG for groups A and B were 8.90 ± 4.07 dB and 12.00 ± 5.41 dB respectively and this difference was also statistically significant (<em>P</em> value = .03).</div></div><div><h3>Conclusion</h3><div>Utilization of hyaluronic acid gel as an adjunct to temporalis fascia graft tympanoplasty can improve the graft success rate.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512334"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tricolemoma nasal: una localización excepcional para un tumor infrecuente","authors":"Brian Hernández Martín,&nbsp;Alejandra Arenas Rodríguez,&nbsp;Marta González Vega,&nbsp;Irene Expósito Remedios","doi":"10.1016/j.otorri.2026.512343","DOIUrl":"10.1016/j.otorri.2026.512343","url":null,"abstract":"","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512343"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemangioma cavernoso de cuerda vocal: experiencia de seis casos y revisión de la literatura","authors":"María Landa-Garmendia,&nbsp;Alfonso Rodríguez-Urzay,&nbsp;Maider Andueza-Guembe,&nbsp;Leire Álvarez-Ceballos,&nbsp;Mikel Landa-Aranzabal","doi":"10.1016/j.otorri.2026.512342","DOIUrl":"10.1016/j.otorri.2026.512342","url":null,"abstract":"<div><h3>Introduction</h3><div>Laryngeal hemangiomas are rare benign vascular tumors. In adults, the cavernous form is more common. Due to their appearance, they are frequently confused with vocal fold polyps or, less commonly, with malignant lesions.</div></div><div><h3>Material and methods</h3><div>We present a descriptive retrospective study of six patients diagnosed with cavernous hemangiomas of the vocal cord, histopathologically confirmed between 2006 and 2023 at Hospital Universitario Donostia.</div></div><div><h3>Results</h3><div>All patients were referred for dysphonia. In most cases, the initial diagnosis was vocal fold polyp. Five patients underwent laryngeal microsurgery using cold instruments, with good functional outcomes and no long-term recurrences.</div></div><div><h3>Conclusions</h3><div>Cavernous hemangioma of the vocal cord is a rare benign vascular tumor in adults. It initially tends to cause dysphonia and is commonly misdiagnosed as a laryngeal polyp. Treatment is mainly surgical through laryngeal microsurgery with good functional results and no local recurrence.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 4","pages":"Article 512342"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supraglottic CO2 laser laryngectomy: Real-world outcomes from a single-institution cohort","authors":"Carlos M. Chiesa-Estomba,&nbsp;Maria Landa-Garmendia,&nbsp;Alfonso Rodriguez-Urzay,&nbsp;Aitor Vargas-Alvarez,&nbsp;Ekhiñe Larruscain-Sarasola,&nbsp;Jose A. González-García,&nbsp;Maider Andueza-Guembe,&nbsp;Jon A. Sistaga-Suarez","doi":"10.1016/j.otorri.2026.512325","DOIUrl":"10.1016/j.otorri.2026.512325","url":null,"abstract":"<div><h3>Introduction</h3><div>Supraglottic laryngeal cancers often present at advanced stages and carry poorer prognoses than glottic tumors. Transoral CO₂ laser microsurgery (TOLMS) offers a minimally invasive, organ-preserving alternative, but functional morbidity remains a challenge.</div></div><div><h3>Materials &amp; Methods</h3><div>To evaluate oncological and functional outcomes of supraglottic partial CO₂ laser laryngectomy in a single-institution. Thirty-six patients treated with supraglottic partial CO₂ laser laryngectomy were analyzed retrospectively. Demographic, clinical, surgical, oncological, and functional outcomes were reviewed. Survival was analyzed using Kaplan–Meier estimates, and differences were tested with the log-rank test.</div></div><div><h3>Results</h3><div>Mean age was 64 ± 8 years, with 83.3% male patients. Most tumors were pT2 (47.2%). Free surgical margins were achieved in 69.4% of cases. Three-year overall and disease-specific survival rates were 63.9% and 69.4%, respectively. Persistent gastrostomy dependence was observed in 3 (8.3%) patients. Tracheostomy was required in 4 (11.1%) patients, with persistent tracheostomy required in just 1 (2.8%) patient.</div></div><div><h3>Conclusions</h3><div>Supraglottic partial CO₂ laser laryngectomy offers oncologic outcomes comparable to published series. However, functional morbidity remains significant and warrants careful patient selection and preoperative counseling.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 3","pages":"Article 512325"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148003070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comentario sobre: «Resultados de las versiones españolas del Cuestionario de otitis media crónica-12 (COMQ-12) y del Inventario de beneficios de otitis media crónica (COMBI) en pacientes y controles en nuestro medio»","authors":"Shyam Sundar Sah ,&nbsp;Abhishek Kumbhalwar","doi":"10.1016/j.otorri.2025.512313","DOIUrl":"10.1016/j.otorri.2025.512313","url":null,"abstract":"","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 3","pages":"Article 512313"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avances en el manejo de la rinosinusitis crónica con pólipos nasales. Revisión de estrategias multidisciplinares e innovaciones en tratamientos biológicos","authors":"Isam Alobid ,&nbsp;Alfonso del Cuvillo ,&nbsp;Joaquim Mullol ,&nbsp;Serafín Sánchez-Gómez","doi":"10.1016/j.otorri.2026.512341","DOIUrl":"10.1016/j.otorri.2026.512341","url":null,"abstract":"<div><div>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the upper airways, characterized by a type<!--> <!-->2 (T2) immune response and frequently associated with respiratory comorbidities such as asthma, allergic rhinitis, and NSAID-exacerbated respiratory disease (N-ERD). Its management has evolved from a symptomatic medical-surgical treatment approach toward precision and personalized medicine, based on molecular-level knowledge of inflammatory endotypes. Biological therapies have shown efficacy in patients with severe uncontrolled disease, both sinonasal and bronchial, and are currently available within the Spanish healthcare system.</div><div>However, key challenges remain: the lack of validated clinical biomarkers, uncertainty about the optimal duration of treatment, its combination with sinonasal surgery, and the high cost of biological therapies. In this context, the integration of data science and Big Data technologies in the Spanish healthcare system represents a strategic opportunity to generate real-world evidence, improve clinical decision-making, and advance toward a more equitable, efficient, and sustainable model of precision medicine.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 3","pages":"Article 512341"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148003050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-Making in Meningoencephalic Herniation in the temporal bone: A report of 95 cases","authors":"Tommaso Mazzocco ,&nbsp;Carlos Martin-Oviedo ,&nbsp;Monica Rueda Vega ,&nbsp;Montserrat Asensi-Diaz ,&nbsp;Manuel Gutierrez-Triguero ,&nbsp;Ignacio Aristegui ,&nbsp;Miguel Aristegui","doi":"10.1016/j.otorri.2025.512304","DOIUrl":"10.1016/j.otorri.2025.512304","url":null,"abstract":"<div><h3>Introduction</h3><div>Meningoencephalic herniation (MEH) of the temporal bone is a rare but potentially life-threatening condition that may lead to meningitis, encephalitis, cerebral abscess, or epilepsy. Its incidence appears to be increasing, particularly in spontaneous cases, which are frequently multifocal and associated with obesity and benign intracranial hypertension.</div></div><div><h3>Materials and methods</h3><div>A retrospective review was performed of 88 patients (95 cases) surgically treated for MEH at a tertiary referral center between January 2000 and February 2023. Inclusion criteria were intraoperatively confirmed MEH and a minimum follow-up of six months. Data collected included demographics, aetiology, surgical approach, symptoms, otoscopic findings, body mass index (BMI), imaging, complications, recurrences, and audiometric outcomes.</div></div><div><h3>Results</h3><div>The cohort comprised 35 females and 53 males, aged 22–78 years (mean 54.5). Seven patients had bilateral MEH. Aetiology was idiopathic in 46 patients, post-surgical in 29, cholesteatomatous in 10, and traumatic in 3. Surgical approaches included middle cranial fossa (57 patients), transmastoid (21), and subtotal petrosectomy (17). Hearing loss was the most common symptom (22 patients), followed by ear fullness (18), otorrhea (17), and meningitis (16). Life-threatening manifestations occurred in 34.5% of cases. Complications were reported in 11 patients, all transient or medically managed. Mean BMI was 30 (range 21–44); all patients with BMI &gt; 34.99 had idiopathic MEH. Multiple hernias were strongly associated with idiopathic origin. No recurrences were observed.</div></div><div><h3>Discussion</h3><div>Surgical repair is indicated in all confirmed cases of meningoencephalic herniation to prevent intracranial complications. The selection of approach is guided by hearing status, location, and aetiology. The middle cranial fossa approach is preferred in most spontaneous or multifocal cases, whereas subtotal petrosectomy is reserved for non-serviceable hearing or poor general condition. The transmastoid approach is suitable for isolated defects in the tegmen antri. Autologous grafts remain the gold standard for reconstruction.</div></div><div><h3>Conclusions</h3><div>The rising incidence of spontaneous MEH highlights the need for tailored surgical strategies. We present one of the largest surgical series of MEH to date and confirm that a tailored surgical strategy is essential for achieving successful outcomes. Our data support an algorithm based on hearing status and aetiology to optimize outcomes while minimizing complications.</div></div>","PeriodicalId":7019,"journal":{"name":"Acta otorrinolaringologica espanola","volume":"77 3","pages":"Article 512304"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148003067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}